Allergic Rhinitis

Allergic Rhinitis

Also known as hay fever, is a type of inflammation in the nose which occurs when the immune system overreacts to allergens in the air.

Allergic rhinitis is a very common condition of the nose. When most patients say they have “sinus” issues, they usually are referring to allergic rhinitis. It is very common in Singapore due to the high humidity and it is believed that 20% of the population may have this condition. The incidence is higher in the pediatric population.

Frequently the patient is extra sensitive to airborne allergens e.g. house dust mites, molds, cat’s or dog’s dander or grass. This can trigger a reaction within the nose resulting in blocked nose, runny nose and sneezing. It is uncommonly related to food allergens.

The treatment includes nasal sprays and antihistamine tablets. For severe allergic rhinitis, an allergy test such as a skin prick test can be performed to see what the potential triggers are. Allergen avoidance is key to treatment of allergic rhinitis. For recalcitrant problematic cases of allergic rhinitis, nasal surgeries can be performed to improve nasal airflow.

A skin prick test done on a patient. This is a painless test with high accuracy and results are obtained in 30 minutes.

Skin Prick Test

Picture of a patient’s forearm after a skin prick test. The size of the bump is measured and the offending allergen is known.

There are several ways to reduce exposure to known allergens. It can sometimes be difficult to completely avoid the allergen. However if you can reduce the amount of allergen exposure it can help.

The first step is allergen avoidance. After an allergy test is done and allergens avoided, nasal sprays can be given to help in the short term. A saline spray is done to clean the nose of allergens that could have lodged in the nose and sinus cavities. A medicated nasal steroid spray is then used to help reduce inflammation in the nose. The nasal steroid spray has very minimal absorption in the systemic blood stream and is very safe to use in the short term period.

Antihistamine tablets can be used as adjunctive treatment to help alleviate nasal congestion, runny nose and sneezing.

Immunotherapy

Based on the skin prick test results, immunotherapy can sometimes be prescribed for patients who do not respond well to nasal sprays and tablets. These used to be administered in the form of injections but nowadays, it’s been simplified to sublingual tablets for ease of administration. However this is a 3 year course of medication so long-term commitment is important for a good outcome.

For patients who are very troubled by nasal congestion despite treatment with all the above, a simple procedure to reduce the size of the inferior turbinates (radiofrequency) can be performed. The inferior turbinate is a structure that is commonly enlarged during allergic rhinitis. This can be performed under local anaesthesia in the clinic and patients can return to work after.
Allergic Rhinitis

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